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  • Title: Women with spinal cord injuries require sensitive reproductive care.
    Author: Bertosa H, Cellura M, Pierce L, Rothacker C.
    Journal: MCN Am J Matern Child Nurs; 1993; 18(5):254-7. PubMed ID: 8264350.
    Abstract:
    In the US, a spinal cord injury permanently disables about 3600 women annually. Many of these women can conceive, have full-term births, and raise a child. Rehabilitation specialists and obstetrician/gynecologists tend not to address the needs of disabled women. Yet, all women with spinal cord injuries need routine gynecologic exams and counseling about contraception and sexuality. Lack of access to transportation and buildings limits their ability to enter the health care system. Nurses can help by maneuvering the wheelchair and positioning the women on the examination table. Disabled women have the same concerns as other women but are also concerned about skin integrity, bowel and bladder management, transfer techniques, and their ability to manage their own care. Nurses should not let the wheelchair or paralysis affect interpersonal care. When the disabled patient makes an appointment, health care workers should remind her to evacuate her bowels and bladder before the gynecologic exam. They should schedule the exam when the staff are not busy. Nurses should take a medical history and determine the patient's needs and what body areas have no sensory capabilities. Padding on the stirrups and table protects skin integrity. Nurses must be aware of the possibility of pain an/or autonomic dysreflexia in women with spinal cord injury above thoracic level 5. Clinicians should do a breast exam and instruct the disabled patient to do a monthly breast exam herself or to choose someone to do it for her. The health care worker should help the disabled patient with perineal hygiene, clothing, and repositioning during which he/she can discuss sexuality and contraception. The health care worker should dispel myths about sexual function and expression of disabled women. He/she should inform her about the advantages and disadvantages of using various contraceptives as they apply to her spinal cord injury. He/she should support her decisions on contraception.
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